Registration: Salem University Step 1 of 714%Thank you!Is the student learner currently enrolled in high school?* Yes NoStudentName* First Last Date of Birth* DD dash MM dash YYYY Gender*Email Address* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Age VerificationPlease confirm your age using the following options:* I am 18 years of age or older I am younger than 18 years oldEmergency ContactWe will only reach out to your emergency contact if we are unable to reach you through the contact methods you have provided.Name* First Last Email Address* PhoneSocial Security Number*Ethnicity**American IndianAsianBlack or African AmericanGuatemalanHispanicNative Hawaiian or Pacific IslanderNonresidentNot SpecifiedTwo or More RacesWhiteCitizenship Status**Alien ResidentEligible Non-CitizenNon-CitizenUnknownUS Citizen*We collect this information on behalf of Salem University as part of their reporting requirements for accreditation.Parent/Guardian 1Name* First Last Email Address* Phone*Parent/Guardian 2Name First Last Email Address PhoneSection BreakAcknowledgementItem 1* I acknowledge that my student is academically capable of successfully completing these online courses.Item 2* I understand that the drop period for these courses is 15 days after enrollment.
